Medicare fraud: Feds convict Texas physician in $16 million scheme

October 11, 2019

Texas physician submitted fraudulent Medicare claims and other documents and charged home health agencies illegal kickbacks

A Texas physician was convicted in Federal Court on October 7 of taking part in a $16 million Medicare fraud scheme, according to a news release from the Department of Justice.

A jury handed down the guilty verdict against Yolanda Hamilton, MD, 65, of Harris County, Texas, on single counts of conspiracy to commit healthcare fraud and conspiracy to solicit and receive healthcare kickbacks, and two counts of false statements relating to healthcare matters after a six-day trial.

Hamilton, the owner and operator of HMS Health and Wellness Center, PLLC, conspired with others to defraud Medicare by signing false and fraudulent plans of care and other medical documents between January 2012 and August 2016, according to the news release.

The group also submitted fraudulent claims to Medicare to make it appear that their patients qualified for and received home healthcare services under the program, while paying the patients to sign up and recertify for the services when they were often not medically necessary, not provided, or both, the release said.

Hamilton also charged home health agencies an illegal kickback in the form of a “patient fee” for certifying and recertifying the patients for the services which the agencies, not the patients, would pay.

The scheme led to about $16 million in false and fraudulent claims to Medicare, prosecutors said.

Several others involved in the scheme have already pleaded guilty or were found guilty at trial for their roles. Several who purchased plans of care and other signed medical documents from Hamilton have been charged, found guilty, or pleaded guilty to conspiracy to commit healthcare fraud and/or pay or receive kickbacks, the release said.

The case was investigated by the FBI and HHS. It was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Texas.

The Fraud Section of the Department of Justice leads the strike force, which, since its inception in March 2007, has charged more than 4,200 defendants who have collectively billed the Medicare program for more almost $19 billion.

This conviction comes hot on the heels of the September 27 announcement of Federal indictments being filed against 35 people across the country accused of fraudulently billing Medicare for more than $2.1 billion.

That scheme involved cancer genetic testing laboratories paying illegal bribes and kickbacks to medical professionals working with fraudulent telemedicine companies in exchange for referrals of Medicare beneficiaries for expensive unnecessary cancer genetic tests. Some defendants are also accused of using telemarketing networks to draw hundreds of thousands of seniors into the scheme.